Provider Demographics
NPI:1194318691
Name:RESTORE BEHAVIROAL HEALTH
Entity type:Organization
Organization Name:RESTORE BEHAVIROAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:
Authorized Official - Last Name:ATLAS
Authorized Official - Suffix:
Authorized Official - Credentials:JD, LPC
Authorized Official - Phone:770-899-8703
Mailing Address - Street 1:1954 AIRPORT RD # 104
Mailing Address - Street 2:
Mailing Address - City:CHAMBLEE
Mailing Address - State:GA
Mailing Address - Zip Code:30341-4956
Mailing Address - Country:US
Mailing Address - Phone:770-899-8703
Mailing Address - Fax:
Practice Address - Street 1:1954 AIRPORT RD # 104
Practice Address - Street 2:
Practice Address - City:CHAMBLEE
Practice Address - State:GA
Practice Address - Zip Code:30341-4956
Practice Address - Country:US
Practice Address - Phone:770-899-8703
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-16
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty